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Saturday, November 8, 2014

Neuromuscular Re-Education-- or "It's all about your butt!"

So, two weeks ago, Bob had his four week "re-certification" at Outpatient Rehab. He passed speech with flying colors, not so much PT...

Once again, he's caught in that "plateau" trap, the "no progress" or "slow progress" and "no functional improvement" crap and he's about to be booted out of the insurance-paid-for-therapy door....

This time, however, because Bob has a trust fund and we can afford to private pay for therapy, Bob's PT did some legwork and a found a highly recommended personal trainer at a local fitness studio who specializes in stroke and brain injury rehab.

Friday, we went to the fitness studio for a "free consultation" and "evaluation" with the personal trainer.

And I tell you, it was very different from the usual insurance-paid-for-therapy evaluation. In fact, the "therapy" is very different from anything we've run into at all the different rehab centers we have frequented in these past four years. This place practices the "BEST method" (stands for "Better Educated Strength Training") and the stroke rehab program concentrates on "neuromuscular re-education" and this therapist/personal trainer actually talked about things like "neuroplasticity" and "brain-to-muscle connectivity" and things I've really only read about -- up to now.

So, this sounds like pretty exciting stuff....

Our one hour evaluation consisted mostly of the trainer explaining the theory of "neuromuscular re-education" which is basically re-training the brain to take back control over the muscles, then taking Bob's history, and checking out Bob's range of motion. Then we got, what I will call for lack of a better term, "The Butt Lecture." Which went, something like this:

Your Butt is the largest muscle in your body.

As the largest muscle, your Butt is connected to and affects all other muscles in your body.

If your Butt is weak, your whole body will be weak!

If your Butt is weak, you will be unable to properly stand or walk!

A weak Butt will make you walk hunched over and unstable!

A weak Butt will cause your spine to twist!

And sitting on your Butt all day, weakens your Butt!!

Therefore, step 1 in the program will be to Strengthen

Your Butt!!!

He then asked Bob to squeeze his butt cheeks together. I was really unsure if Bob could even do this -- in fact, I really don't remember any therapist ever asking him to do this -- but lo and behold, Bob did manage to do a butt squeeze, albeit a sort of wimpy squeeze.

This PT says Bob needs to work on his butt squeezes, and then he needs to work on being able to squeeze one butt cheek at a time, and alternate each side -- I'm thinking, huh? Can a person really do that? And you know, I tried it (right there in that therapy room), and tried it again (at home), and, um, am still trying this ---and heck, I don't think it's even possible! -- but then, I am no butt expert. Perhaps, my butt is weak, too!

The "evaluation" was coming to an end, and I asked what type of equipment they used. And the PT told me they would not be using equipment with Bob, at least not right away. That his first goals for Bob would be 1) butt strengthening and 2) re-training Bob's brain to control Bob's neck muscles so Bob could hold his head upright again.

Then, he told me that all the other therapists had been attacking Bob's neck problem all wrong. That those therapists had been, hands-on, stretching Bob's neck muscles for him and this was in no way training Bob's brain to hold his head upright and that could only be done by teaching Bob some methods to stretch his own neck...

So, after Bob's neck is straighter and his butt stronger, the therapist would then work on standing and taking steps.

And, he said, he would also like to see Bob move his right hand and arm. And I'm thinking, what?! Is that even possible? Four years post-stroke?

I mean, Bob's right arm/hand have been pretty much "dead" now for four years and every other therapist has given up on it, so I tell the guy this, and he tells me about one of their other clients, who also suffered a massive stroke, and three years ago he came to them in a wheelchair, unable to stand or walk, and all his previous therapists had told him that he would never walk again and today, he is walking with a cane...

So I called Bob's trustee and she's sending a check, and I signed Bob up for eight weeks of "neuromuscular re-education" therapy (2 times/weekly) and we'll see what happens....

Should be interesting.

Makes me sad, though, to know these types of therapies are out there, and available, but only to those who can afford it. Bob's eight weeks will cost $960, something we never could have paid for, before....

So, I'll share what we learn here!

Right now, everyone, Lesson #1: Squeeze Those Butt Cheeks!!!! (and if anyone figures out how to squeeze one cheek at a time, let me know.... )

8 comments:

During the initial months of recovery PT, my husband, Sam was made to do as many pelvic and butt squeezes as he could manage. Your 'Butt' explanation makes sense now! :)Love and good wishes from our corner of the world.

Interesting to say the least. Nope, couldn't squeeze one cheek at a time. Though "out of pocket", $960 for 16 sessions doesn't sound all that bad, it's so good Bob can begin that treatment using the trust fund. I sincerely hope he can make some progress through this therapist.

Strange that PT emphasizes butt muscles after a hip replacement but not after a stroke. I remembered it after my stroke and did them.

The focus for hospital based is central core where private will take one set of muscles at a time. Your butt is also part of your central core. But by saying central core they focus on abdominal muscles first.

To squeeze one cheek, focus the back muscles on one side and then squeeze. But first you need to strengthen both to isolate one side.

There is a huge difference between private trainers and hospital based. 1) they are paid for results, and 2) they can focus on one area versus the body as a whole. Stick with the private pay as long as you can to get your old Bob back is my advice. I wish I had that option.

A new muscle routine always wakes up the body and mind. I like the idea of teaching Bob how to stretch his neck instead of waiting for a therapist to do it passively. Butt training is essential for standing up. If Bob can help during a transfer it will put less stress on your back.

It sounds really exciting for you and Bob. I was fortunate to do group aquatic therapy led jointly by a special trainer and my regular Physiotherapist. One day the trainer asked us to do butt squeezes. I was so shocked to find that only on check squeezed. Knew my leg wasn't doing much but the butt too?? Anyway it was not really that long once I started working on it before I got some improvement in my cheeks and that really helped my gait.

Thankyouthankyouthankyou!!!! That makes SO much sense, I,looked for, and found, a trainer that says he does "neuro-muscular re-education", and am waiting for a call back. This is exciting, isn't it. I do so hope it helps Bob.

Welcome To Our Pink House

About Me

Bob and I were married 09/16/94. He is my soulmate, the love of my life. Bob is an artist and I am a writer.
On 10/20/10, Bob, following his doctor's advice, underwent a carotid endarterectomy. When I left him in ICU that night, he was fine and I thought in good hands. Two hours after my departure, a nurse noted on his chart that Bob's speech was slurred and his right arm was paralyzed. The nurse did not call a doctor. Later that night, the nurse noted that Bob could not move his right arm or leg, still a doctor was not called. The next morning, the nurse noted that he was paralyzed on the right side, a "12" on the Glasgow Coma Scale, disoriented and confused, but no doctor was informed. I arrived at 9:00 a.m. and immediately called for the doctor. He was rushed to surgery. It was 12 hours too late. The CAT scan showed 2/3 of his brain had been damaged. I was told he would not survive. Somehow, he did.
Bob was discharged from the hospital on 12/31/10 and, although the hospital wanted him sent to a nursing home, I brought him home instead. This is the story of our journey since that day. This is also a love story.
(Bob passed away 5/28/15 and I am trying to survive....)